Facility Evaluation Report

On 08/30/25 Licensing Program Analyst (LPA) Marcela Yanez conducted an unannounced case management-incident and met with Cyril Inneh, Administrator (ADM). LPA announced the purpose of the visit. LPA observed 5 residents and 3 staff.

ADM stated the incident occurred on 08/30/25 approximately 4:00 PM Resident (R1) was walking down the stairs leading to the backyard and to the kitchen and accidentally fell, the facility stairs has a hand rail on the left side. ADM submitted an Incident Report on 09/08/25.

ADM stated Staff S1 witnessed when R1 fell. S1 stated that the R1 was cognitive and able to stand but was shaky and unstable. S1 called 911 and ADM. R1 was taken via ambulance to emergency room.

ADM stated the resident was placed on a ventilator and diagnosed with a subdural hematoma. ADM submitted a Death Report LIC 624A to the department on 09/08/25.

on 09/05/25 R1 passed away, ADM stated R1's conservator stated R1 passed away from Subdural Hematoma. ADM stated he has notified all responsible parties including Benefits Management Corporation of Resident death.

LPA determined the incident does not require further investigation.

No deficiencies were cited at this time as per California Code of Regulations Title 22.

This report was reviewed with Administrator, Cyril Inneh and a copy of the report was provided